elbow assessments Flashcards
what are the components of elbow assessments
- Observation
- Active movements
- Passive movements
- Accessory movements
- Isometric muscle testing
- Special tests
- Palpation
- Muscle length
- Neurological tests
- Functional tests
- Check surrounding joints
What are the joints of the elbow
humeroulnar (hinge)
radiohumeral (hinge)
superior radioulnar (pivot)
what are the key points of observation
- UPPER LIMB OBSERVATION
- Above Below
- Dynamic & Static Situations
- Quality of movement
- Posture characteristics
- Muscle form
- Soft tissues
what are checks that should be made during observation
- Hyperextension deformity
- Limited flexion
- Medial tilt and lateral angulation at the elbow
- Prominence of lateral condyle of humerus
- Gunstock deformity
- Wasting of muscles
what is gun-stock deformity
caused by malunion of supracondylar Fx
varus in coronal plane, extension in sagittal plane, internal rotation in transverse plane
what is the expected ROM for movements around the elbow?
- Flexion (0-55 deg)
- Extension (0-15 deg)
- Supination (70 deg)
- Pronation (80 deg)
what are possible accessory movements around the elbow
Distraction of olecranon on humerus
distraction of radius on humerus
PA glide radius on humerus
AP glide radius on humerus
how is distraction of the olecranon from humerus conducted
pt in supine, 70 degrees flexion at elbow and 10 degree supination, fixate humerus with one hand and laterally pull dorisilly and distally
how is distraction of the radius conducted
pt has arm resting on plinth or table, full extension with 5 degree supination
fixate humerus and palpate joint line with finger
hold radius distally and perform traction
How is PA and AP conducted at the radius and humerus
pt sat with arms on plinth or table
elbow moved to 5 degree supination and slight flexion, fixate humerus one hand and palpate joint line with thumb
other hand finds radius
PA pressure is applied towards patients chest
AP remove extensors of forearm to find dip and head of radius, then movement is distal and caudal
what muscles are tested in each isometric muscle tests?
Flexion: biceps brachii, brachialis, brachioradialis
Extension: triceps
Supination: supinator, biceps brachii
Pronation: pronator teres, pronator quadratus, flexor carpi radialis
How are the varus / valgus stress tests conducted?
Assesses integrity of the lateral collateral ligaments
Pt standing or sat
place elbow in slight flexion and palpate humeroulnar joint line
apply varus / valgus force to elbiw
test at both 5 and 30 degrees
positive with pain / laxity
What is the test for lateral epicondylopathy and how conducted
Maudsley’s test (tennis elbow)
pt with forearm on plinth/table
palpate lateral epicondyle with forearm pronated and elbow slightly flexed, extension of 3rd digit / 2nd finger is resisted
positive if pain is reproduced
how is medial epicondylopathy identified
with the golfers elbow test
palpate medial epicondyle with forearm supinated and elbow and wrist extended
positive if pain on medial epicondyle
How is ulnar nerve entrapment tested for?
Tinnel’s sign (elbow)
examiner percusses ulnar nerve in cubital tunnel for 30-60 secs while elbow is flexed,
positive if paraesthesia / numbness down the arm
what functional tests are there for the elbow
press up test (full plank or with knees)
superman plank position
rotating hammer
what education should be provided in relation to epicondylalgia management
- Avoid end range of motion extremes in both extension and flexion.
- Avoid repetitive hand and wrist motions and take breaks from such
activities when necessary to perform them. - Avoid letting heavy items with the arm in full extension; perform work or
weight-lifting partially bent with the elbow. - Use two hands to hold heavy tools and use a two-handed backhand in
tennis. - Limit repetitive grasping and gripping motions.
- If a movement causes the pain to return, avoid it, and report to your
clinician’s office
describe load management for lateral epicomdylalgia
optimised load allows adaptation for the tendon and helps to improve strength
helps to break tendinopathy cycle
reactive tendinopathy: tendon thickening, reduces load to reverse this
tendon dysrepair: greater matrix breakdown, increase in number of cells, increases vascularity
degenerative tendinopathy: areas of cell, little capacity for reversal
how are exercises done for lateral epicondylalgia and progressed
finger flexion, wrist extension and resistance
progress to therabands and dumbbells
eventually proximal strengthening, up to 30% weakness, weakness in proximal muscles increases distal muscle demand
what are the goals for supracondylar fracture treatment
achieve painless and full elbow mobility
enhance healing process
strengthen affected musculature
improve overall functional abilities
what kind of exercises are recommended for supracondylar fractures
active exercise and ADLs are recommended rather than passive mob or stretching
optimal loading pain-free activities are necessary for paediatric fractures to aid healing process
should avoid activities with weight-bearing, loading and pushing
progressive strength exercises can be adressed
what immobilization period is there for supracondylar fractures
elbow immobilized for 3 weeks
adjacent joints kept moving with active and active-assisted exercises frequently
elbow shouldn’t be moved
what kind of exercises should be done 1-2 weelks after cast removal
gentle tissue release arm and forearm
gentle active and AA exs with wand in pain-free way frequently
isometric arm and forearm exs
educate parents and child to use affected hand to use in daily activities
avoid weight-lifting and pushing activities
